The Diagnostic and Statistical Manual published by the American Psychiatric Association is currently being revised and will be called DSM-5 when it is published in 2013. There will be 6 criteria for what they will call Hoarding Disorder, two of which rule out symptoms due to other conditions (a medical illness or obsessions in Obsessive-Compulsive Disorder). Like other disorders in the DSM, a third criterion mandates that the hoarding must cause clinically significant distress or pose a threat to the person’s health or the health of others. In the case of hoarding, this means that the individual experiences the hoarding as what is called "ego dystonic," meaning that the hoarder finds the behavior disturbing even while he or she feels unable to stop it. Hoarding disorder will be a new category in DSM-5 because, as the authors explain, this will "increase public awareness, improve identification of cases, and stimulate both research and the development of specific treatments for Hoarding Disorder." Although hoarding used to be a subcategory of obsessive-compulsive disorder (OCD), it would now be a stand-alone disorder, because the DSM-5 authors believe it often occurs in the absence of OCD.
The new criteria for hoarding disorder to be included in DSM-5, then, will include:
1. Persistent difficulty discarding or parting with personal possessions, regardless of their actual value.
2. This difficulty is due to strong urges to save items and/or distress associated with discarding them.
3. The symptoms lead to extreme cluttering of the home or workplace that renders them unlivable or unusable.
4. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning which may include maintaining a safe home or work environment.
5. The hoarding is not attributable to another medical condition such as dementia.
6. The hoarding is not attributable to another psychological disorder such a major depressive disorder or obsessive-compulsive disorder.
There are no distinct "diagnostic" criteria for collecting, however, Nordsletter and Mataix-Cols (who is one the DSM-5 Task Force) evaluated the research evidence on collecting to determine the extent to which collecting overlaps with hoarding, Nordsletter and Mataix-Cols evaluated each of the DSM-5 criteria against the known characteristics of collectors. Four of these proved particularly relevant:
Criterion #1: Difficulty Discarding and Value of Objects
Collectors seem more flexible in the way they establish and hold onto their valuables than do hoarders. they may begin collecting one type of book as children, for example, and as they mature, switch to different types of books (e.g. action books as children to mystery books as adults). Collecting seems to go through its own natural life cycle with perhaps as many as 70% of children having some type of collection but only 23% of those in their 20s. By the age of 60, only 13-15% of the population is estimated to have a collection. The only hitch in this line of thinking is that people may be less likely to collect new items as they get older, but they may find it very difficult to part with their possessions.
Collectors also trade or sell all or parts of their collection without experiencing the mental anguish of a hoarder. It’s not clear how many collectors actually do sell or reduce their collections over time, but the more likely they are to do so, the less likely it is that are true hoarders.
Regarding the value of their collection, hoarding is defined as difficulty parting with items regardless of their value. Hoarders may collect truly valuable items, but they may also collect – quite literally—garbage. Collectors may also collect items of little intrinsic value such as mass produced toys that only gain worth because they are no longer available (think vintage Barbie dolls or Happy Meals from the 1980s). Because it’s not possible to define “valuable,” then, the important criterion seems to be that the individual has trouble parting with objects regardless of their actual value.
Overall, the study’s authors believe that some collectors may actually fulfill this first criterion for hoarding, especially if they become distressed not just at discarding, but at the prospect of discarding their collections. Without pathologizing the average hobbyist or Antiques Road Show fan, it seems safe to conclude that the continuum from collecting to hoarding seems to slant more toward hoarding when this criterion of difficulty discarding objects regardless of their value comes into play. For now, you can hold onto your vintage collection of Lionel trains.
Criterion #2: Strong Urges to Keep and Distress at Throwing Out
As much as they may prize their collections, people who are more collector than hoarder don’t seem to express worry at the loss of their items or even a strong urge to keep them. Taking into account the factor of what they want done with their collections after they’ve died might be one way of defining distress over giving up a collection, and there is some evidence on this. In one study, as many as 90% of adults 65 and older stated that they would pass their collections down to their inheritors, or have the objects sold or donated. If you’ve ever been on the receiving end of such a collection, you may recall dispensing of the entire set without more than moment’s hesitation and with a good deal of relief. Again, this speaks to the fact that a collection may not be all that inherently valuable to anyone but the collector. The authors concluded that there’s no real way to know from the literature whether putting a collection in your will is the same as showing pathological distress over giving it up while you're alive. However, if collectors specify what’s supposed to happen to the collection in their will, there’s a chance that this reflects attachment that begins to border on hoarding.
Criterion #3: Accumulation and Clutter
A survey of the number of possessions that collectors typically have showed that over half keep fewer than 50 objects in their collections, but 28% had 100 or more. The largest collectors were men in the age range of 18-25 years old. Although this doesn’t seem like a huge percent, Nordsletten and Mataix-Cols pointed out that in order to display these collections, it’s often necessary for collectors to take up a significant amount of their living space. One collector, they noted, had only 10 objects in his collection, but they were tractors.
Despite the invasion of their living space by their collections, non-hoarders show one important difference from their hoarding counterparts. This is that collectors do put their possessions on display rather than letting them accumulate all over homes or apartments. Hoarders may have homes so cluttered with their possessions that they can hardly move. In addition, the hoarded items (which may range from moldy food to ancient newspapers) are strewn around and not put in any sort of displayable order as would a collection. Not all collectors have nice and tidy arrays of their prized objects, but they are much more likely to do so than are people with the disorder of hoarding.
Criterion #4: Clinically significant distress or impairment
As is true for all conditions evaluated in the DSM, hoarding must fulfill the criterion of causing significant distress in a person’s daily life. This means that hoarders have difficulty holding onto their jobs, maintaining normal family ties, and residing within the community. The distress they experience also translates into feelings of shame or regret and they wish they could stop their hoarding (i.e. "ego dystonic").
Unlike hoarders, average collectors have strong family relationships, interact in a social context with other collectors, and don’t experience guilt or regret. They participate in an active community of collectors, developing friendships within the community, and may even share their interests with family members.
In examining the overlap between hoarding and collecting, Nordsletten and Mataix-Cols conclude that, at worst, a collector may fit Criteria #1 and #2 (as well as having other medical or mental illnesses). However, the average collector does not meet Criteria #3 or #4. The average collector also does not show patterns of excessive acquisition or lack of insight into their condition, behaviors that are evaluated during a DSM assessment.
At the risk of defining a normal behavior as abnormal, though, it’s important to be aware that there may be a subgroup of “Extreme Collectors” who meet all the criteria of hoarding but have not been diagnosed. These avid collectors may go undetected among the collecting population because they seem to be engaging in the same behaviors as the average collector. The key differences between them and average collectors seem to rest in Criteria #3 and 4.
Extreme collectors often become involved in more than one type of collecting behavior. Their living spaces become increasingly overrun by their objects. Although unlike hoarders, their collections are orderly, if they become large enough (or their home is too small), they do live among clutter. Extreme collectors may also invest a considerable amount of money and effort in their collecting behavior, which can begin to have negative effects on their jobs and family lives. They may also begin to feel guilty and become socially isolated as they disappear more and more into their collections. Some of these individuals may have another psychological disorder or a medical condition (such as dementia) that leads to or exacerbates their symptoms. They don’t take pleasure in collecting, and aren’t part of the community of collectors that can often develop among average collectors.
Just because you enjoy collecting, and may even have a few stashes around your home or office of objects that mean more to you than they do to others, this should not be a cause for alarm. However, when you, or someone you know, starts to show those extreme collecting signs (#3 and #4), it may be time to seek help. Fortunately, even cases of severe hoarding respond to psychotherapy, particularly cognitive-behavioral therapy geared specifically to this condition. Check out the two resources at the bottom of this post, which will also lead you to other helpful links.
At the opposite extreme, don’t rush to conclude that because you or a loved one has one (or more) collections, it means a diagnosis of hoarding disorder is in order. All psychiatric diagnoses must meet rigorous criteria before they are applied. As long as you enjoy your hobby, don’t let it run your life, modify your collecting preferences over time, and are able to share your interests with others (including family), there is every reason to keep it a vital part of your life for years to come.
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Copyright Susan Krauss Whitbourne 2012
Nordsletten, A. E., & Mataix-Cols, D. (2012). Hoarding versus collecting: Where does pathology diverge from play?. Clinical Psychology Review, 32(3), 165-176. doi:10.1016/j.cpr.2011.12.003
Dr. Gail Steketee’s home page
About.com Hoarding Treatment.